Patient and provider characteristics associated with therapeutic intervention selection in a chiropractic clinical encounter: a cross-sectional analysis of the COAST and O-COAST study data

Chiropractic & Manual Therapies

Research

Jan Hartvigsen¹  Casper Glissmann Nim²  Hazel J Jenkins³  David McNaughton³  Aron Downie³  Simon D French³  Cecilie K Øveras⁴  Jessica J Wong⁵  Silvano Mior⁶  James J Young⁷  Eric J Roseen⁸ 

[1] Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;Chiropractic Knowledge Hub, University of Southern Denmark, Odense, Denmark;Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;Department of Regional Health Research, University of Southern Denmark, Odense, Denmark;Spine Centre of Southern Denmark, University of Southern Denmark, Odense, Denmark;Department of Chiropractic, Macquarie University, Sydney, Australia;Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway;Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada;Institute for Disability and Rehabilitation Research, Ontario Tech University, Oshawa, Canada;Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada;Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada;Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark;Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedision School of Medicine and Boston Medical Center, Boston, USA;

关键词: Chiropractic;    Therapeutic intervention;    Musculoskeletal disorders;    Patient characteristics;    Provider characteristics;   

DOI  :  10.1186/s12998-023-00515-y

 received in 2023-03-20, accepted in 2023-09-12,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundChiropractors use a variety of therapeutic interventions in clinical practice. How the selection of interventions differs across musculoskeletal regions or with different patient and provider characteristics is currently unclear. This study aimed to describe how frequently different interventions are used for patients presenting for chiropractic care, and patient and provider characteristics associated with intervention selection.MethodsData were obtained from the Chiropractic Observation and Analysis STudy (COAST) and Ontario (O-COAST) studies: practice-based, cross-sectional studies in Victoria, Australia (2010–2012) and Ontario, Canada (2014–2015). Chiropractors recorded data on patient diagnosis and intervention selection from up to 100 consecutive patient visits. The frequency of interventions selected overall and for each diagnostic category (e.g., different musculoskeletal regions) were descriptively analysed. Univariable multi-level logistic regression (provider and patient as grouping factors), stratified by diagnostic category, was used to assess the association between patient/provider variables and intervention selection.ResultsNinety-four chiropractors, representative of chiropractors in Victoria and Ontario for age, sex, and years in practice, participated. Data were collected on 7,966 patient visits (6419 unique patients), including 10,731 individual diagnoses (mean age: 43.7 (SD: 20.7), 57.8% female). Differences in patient characteristics and intervention selection were observed between chiropractors practicing in Australia and Canada. Overall, manipulation was the most common intervention, selected in 63% (95%CI:62–63) of encounters. However, for musculoskeletal conditions presenting in the extremities only, soft tissue therapies were more commonly used (65%, 95%CI:62–68). Manipulation was less likely to be performed if the patient was female (OR:0.74, 95%CI:0.65–0.84), older (OR:0.79, 95%CI:0.77–0.82), presenting for an initial visit (OR:0.73, 95%CI:0.56–0.95) or new complaint (OR:0.82, 95%CI:0.71–0.95), had one or more comorbidities (OR:0.63, 95%CI:0.54–0.72), or was underweight (OR:0.47, 95%CI:0.35–0.63), or obese (OR:0.69, 95%CI:0.58–0.81). Chiropractors with more than five years clinical experience were less likely to provide advice/education (OR:0.37, 95%CI:0.16–0.87) and exercises (OR:0.17, 95%CI:0.06–0.44).ConclusionIn more than 10,000 diagnostic encounters, manipulation was the most common therapeutic intervention for spine-related problems, whereas soft tissue therapies were more common for extremity problems. Different patient and provider characteristics were associated with intervention selection. These data may be used to support further research on appropriate selection of interventions for common musculoskeletal complaints.

【 授权许可】

CC BY   
© Chiropractic and Osteopathic College of Australasia, European Academy of Chiropractic, The Royal College of Chiropractors, Nordic Institute of Chiropractic and Clinical Biomechanics and BioMed Central Ltd. 2023

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